Mo1358 Occurrence of Stricturing and Penetrating Complications Is Diminished in Crohn's Disease Patients Treated by Immunomodulatory and/or Anti-TNF Therapy Within the First Two Years of Disease Duration When Corrected for Diagnostic Delay

Abstract

perianal (n = 18) and other fistulating disease (n = 3). The median duration of anti-TNF therapy was 18 months (range 12 78). 62 patients (87.3%) continued on immunomodulator therapy following anti-TNF withdrawal. Relapse rates after 90 days, 180 days and 365 days were 3/71 (4.2%), 5/67 (7.5%), 12/56 (21.4%) respectively. Of those with perianal disease, the relapse rate was 6/18 (33%) at 365 days. All 6 patients who had dose escalation in the 6 months before withdrawal relapsed. Twenty-five relapsed patients were retreated with anti-TNF agents (9 ADA; 16 IFX), with a response rate of 80% when retreated with same agent as had been withdrawn. 5 patients where IFX was withdrawn responded when retreated with ADA. The overall recapture of response with use of either agent was 84%. Assessment practice changed after NICE guidance was issued in May 2010; before this 6 of 15 (40%) patients stopping anti-TNF therapy had clinical assessment alone. Only 3 of 56 patients (5.3%) were assessed after that date by clinical assessment alone. Conclusions: Relapse rates following withdrawal of antiTNF therapy are lower than previously reported, with a high response rate on retreatment. Patients requiring dose escalation in the 6 months prior to withdrawal may be at higher risk of relapse. We have demonstrated increased endoscopic and radiological assessment prior to withdrawal of anti-TNF therapy. Prospective evaluation of a withdrawal and retreatment strategy for anti-TNF treatment in a larger cohort of Crohn’s patients is required.